Bias, Rationality, and Mental Disorders: The Case for Epistemic Equality

Laura Reinhard Advised by Dr. Lauren Weis Department of and Religion University Honors, Spring 2012

Abstract: in traditional , philosophers assume that rationality is a necessary condition of and true personhood. At the same time, they assert that certain people lack the ability to , discounting the perspectives of entire groups. This capstone project explores bias and rationality in relation to one such group: people with mental disorders. It begins by discussing different conceptions of rationality and notes their ambiguities. By carefully examining some psychiatric conditions—e.g., depression and monothematic delusions—the capstone argues that many people with mental disorders meet the criteria for rationality; therefore, philosophers should not assume that a psychiatric diagnosis precludes rational understanding. Ultimately, the capstone proposes a radical form of epistemic equality that restores the dignity and philosophical privileges of people with mental disorders.

The relationship between philosophy and is complex and illuminates two different intellectual approaches to investigating the human condition. This paper seeks to investigate a point of intersection between the two: the questions raised by cognitive abnormalities in regards to knowledge. It begins by providing a brief sketch of epistemology’s development over time—a daunting task, to be sure—as grounds for considering the importance of reason. I then examine the use of reason in diagnostic criteria and consider depression and monothematic delusions as examples of mental disorders. Finally, I make the case that people with cognitive abnormalities, such as mental disorders, fulfill the criteria for rationality and that their perspectives are valuable to philosophy and psychiatry.

Reason and the History of Philosophy

Philosophers with epistemological concerns have often been preoccupied with what makes someone a knower—that is, capable of acquiring knowledge. For over two thousand years, one of the most consistently cited criteria has been the ability to reason.1 Reason was often defined in relation to other antithetical qualities: one author observes “a longstanding philosophic that opposes reason and passion and attributes madness to an excess of the latter.”2

Moreover, rationality is considered “the mark of humanity” and is privileged in philosophical accounts.3 This association between reason and humanity began with Aristotle, who identifies rationality as the distinguishing characteristic of men when he declares that “a man is a rational

1 For purposes of clarification, I should note that this paper defines rationality as the ability to reason; hence, “rationality” and “reasonableness” are treated as synonyms. Some authors, such as M. Lane Bruner, distinguish between the two concepts. 2 James Phillips, “Madness of the Philosophers, Madness of the Clinic,” Philosophy, Psychiatry, & 16 (2009): 313, http://search.proquest.com.proxyau.wrlc.org/docview/218780822. 3 Licia Carlson and Eva Feder Kittay, “Introduction: Rethinking Philosophical Presumptions in Light of Cognitive Disability,” in Cognitive Disability and Its Challenge to Moral Philosophy, ed. Eva Feder Kittay and Licia Carlson, Series in Philosophy (Wiley-Blackwell, 2010), 1. animal.”4 It is also worth noting that, for Aristotle, females belong to the genus of non-human animals,5 so the ability to reason is exclusively the purview of males. The gendering of reason— and the tendency to deny epistemic equality to certain groups—is intertwined with the history of philosophy. For example, the ancient Greek idea of reason as “a clear, determinate mode of thought” was inextricably linked to maleness.6 The designation of certain groups as inherently more reasonable has far reaching implications, as I will illustrate.

Its gendered subtext aside, reason plays an important role in some of the most preeminent philosophers’ epistemological theories. For Plato, “Knowledge involved a correspondence between rational and equally rational forms.”7 Therefore, who lack rational have muddled perceptions of the world, since they are only capable of seeing the façade of matter. Indeed, Plato’s philosophy reflects the Hellenistic idea that reason permeates the physical world, although he clarifies that matter has no place in our rational cosmos.8 His conception of mind-matter dualism9—which positions the rational mind and illusory, non-rational matter in opposition to each other10—constitutes a vastly important intellectual legacy.11 This division is reflected in other parts of Platonic doctrine: for example, in his understanding of the human soul.12 According to one interpretation, Plato’s tripartite soul even reveals a “philosophic vision

4 Robert Ackermann, Theories of Knowledge: A Critical Introduction (McGraw-Hill, Inc., 1965), 66. 5 Aristotle. “From the ,” in Theories of Knowledge: A Critical Introduction, by Robert Ackermann (McGraw-Hill, Inc., 1965), 92-93. 6 Genevieve Lloyd, The Man of Reason: “Male” and “Female” in (University of Minnesota Press, 1984), 3. 7 Lloyd, Man of Reason, 4. 8 Lloyd, Man of Reason, 4-5. 9 Lloyd, Man of Reason, 5. 10 Lloyd, Man of Reason, 6-7. 11 Lloyd, Man of Reason, 7. 12 Lloyd, Man of Reason, 18-19. of madness as an overcoming of the rational part of the soul by the appetitive side.”13 The

Platonic organization of the world into discrete categories—rational and non-rational, mind and matter, intellectually transcendent and appetitive—is key to understanding his theory of knowledge and peculiarly ordered universe.

Such was Plato’s influence on Aristotle that despite the differences between their philosophical doctrines, the latter experienced a great transformation of thought in regards to the mind-body relationship.14 The similarities between master and pupil are significant enough that together they exemplify “the ancient type of rationality,” “one that appeared from the transformation of the myth to logos.”15 Specifically, both philosophers use systems of categorization that organize things according to quality, although such a system is clearly more evident in the writings of Aristotle. In fact, “Even though the distinction between knowing and valuing had already been made, the hierarchy of values was syncretically identified with the realm of ideas (Plato), and… thinking with the supreme good (Aristotle).”16 However, Aristotle goes a step further in his classification, distinguishing between things like practical political knowledge and theoretical or scientific rationality.17 In keeping with Plato’s mind-matter dualism, Aristotle’s division of knowledge itself fits neatly with his teacher’s philosophical tendencies and method of ordering the world.

13 Phillips, “Madness of the Philosophers,” 314. 14 Lloyd, Man of Reason, 7-8. 15 Vaclav Cernik, Jozef Vicenik, and Emil Visnovsky, “Historical Types of Rationality” (paper presented at the Twentieth World Congress of Philosophy, Boston, Massachusetts, August 10- 15, 1998), http://www.bu.edu/wcp/Papers/Scie/ScieVisn.htm. 16 Cernik, Vicenik, and Visnovsky, “Historical Types of Rationality.” 17 Cernik, Vicenik, and Visnovsky, “Historical Types of Rationality.” See also M. Lane Bruner, “Rationality, Reason and the History of Thought,” Argumentation 20 (2006): 193, doi: 10.1007/s10503-006-9008-9. Of course, Aristotle transcends his role as Plato’s pupil by producing writings of great intellectual depth, and his legacy includes unique contributions to our understanding of reason.

For example, Aristotle radically reinterprets Plato’s idea of the forms:

Plato’s formal principles, Aristotle commented, were rightly set apart from the sensible. But he repudiated Plato’s development of this insight into a dualism between a realm of change, apprehended through the senses, and a different realm of eternal forms. Aristotle brought the forms down from their transcendent realm to become the intelligible principles of changing, sensible things.18

The significance of Aristotle’s reinterpretation lies in its impact on epistemology. He removed knowledge from its Platonic exile in the formal realm and suffused it throughout the material world; thereafter, impermanent and sensible objects became intelligible.19 Aristotle’s position marks the disintegration, however slight, of the rigid divide between the rational and non-rational domains. Further repudiation of Plato is found in book VI of the Nicomachean when

Aristotle clearly lays out a theory of human reason, including a differentiation of its types. The most important aspect of this theory is its pluralism: it emphasizes a rational capacity known as aletheúein, translated as “hitting upon ,” but notes that truth itself has a variety of guises.20

Such an acknowledgment reflects a great deal of flexibility in Aristotle’s theory of knowledge and perhaps even a rejection of the truth as singular, fixed, and eternal. Thus, the two most influential Hellenistic philosophers set out complementary—and, occasionally, contradictory— visions of the ability to reason and its applications in the pursuit of knowledge. The significance of their legacy is evident in epistemology and in the writings of all the philosophers who followed.

18 Lloyd, Man of Reason, 8. 19 Lloyd, Man of Reason, 8-9. 20 Herbert Schnädelbach, “Transformations of the Concept of Reason,” Ethical Theory and Moral Practice 1 (1998): 6, http://www.jstor.org/stable/27504009. The spread of Christianity in the early Common Era had a transformative effect on the intellectual landscape. continued to captivate scholars’ imaginations, but its concepts were filtered through a decidedly Christian lens.21 For example, early Christian philosophers reinterpret logos, or objective reason, through the Gospel of John so that logos became “the entirety of reasonable thoughts of a personal god.”22 This synthesis of the

Hellenistic legacy and Christian doctrine is evident in the writings of Augustine. His preoccupation with the story of Genesis influenced his understanding of rationality, even in the context of gender roles. Augustine asserts that men and women possess an equal ability to reason and that both are entitled to rule over irrational, non-human animals as a result of their divine gift.23 However, despite their equal mental faculties, Augustine also specifies that women are physically subordinate to men; this power dynamic is supposed to be analogous to the subordination of the mind’s practical functions to its contemplative ones.24 (Here, of course, one detects clear echoes of Plato and Aristotle.) The task of interpreting Genesis philosophically was also taken up by Thomas Aquinas in the thirteenth century. Similar to Augustine, Aquinas’s conception of the soul as a unity of various parts and powers informs his ideas about male and female reason.25 Aquinas also asserts that men and women are indistinguishable in the intellectual sense but that women are the complementary sex.26 Despite these glimmers of egalitarianism,

Aquinas, in a later section of the Summa Theologica, cites with approval Aristotle’s assertion that women are not properly describable as ‘continent,’ because they are ‘vacillating’ through being unstable of reason, and are easily led, so that they follow their

21 Lloyd, Man of Reason, 28-29, 33-34. See also Schnädelbach, “Concept of Reason,” 8-9. 22 Schnädelbach, “Concept of Reason,” 8. 23 Lloyd, Man of Reason, 29. 24 Lloyd, Man of Reason, 30-33. 25 Lloyd, Man of Reason, 34. 26 Lloyd, Man of Reason, 35-37. passions readily. And he groups women with children and imbeciles as unable to give reliable on grounds of a ‘defect in reason.’27

Thus, Augustine and Aquinas leave a contradictory epistemological doctrine, one that acknowledges the intellectual equality of the sexes while maintaining that true and independent rationality is the privilege of a specific type of man.

With the reawakening of European consciousness in the Renaissance, Christianity began to assume a slightly diminished role in theories of knowledge, and interpreting rationality according to Genesis-inspired gender roles became less common. Undoubtedly, the image of a rational Creator who bestowed the gift of reason on mankind continued to occupy the greatest minds of the age. For example, asserts that is fundamentally intelligible because it was fashioned by a rational God.28 As such, knowledge is attained through careful attentiveness to nature, including observation and experimentation.29 The centrality of a rational

God also makes an appearance in René Descartes’s philosophy.30 Most significantly, his method prioritizes reason and contemplation to such an extent that he discounts the use of sensory to acquire knowledge. In Cartesian thought, knowledge proper is only obtained through the exercise of reason.31 This emphasis on learning through reason also defied the Hellenistic view, articulated by Plato, that “the acquisition of knowledge depends upon the recollection of past intuitions.”32 But this intellectual shift pales in comparison to the preeminent contribution of Cartesian thought: an epistemological that forever changed

27 Lloyd, Man of Reason, 36. 28 Lloyd, Man of Reason, 10-11. 29 Lloyd, Man of Reason, 11-13. 30 Lloyd, Man of Reason, 43. 31 Ackermann, Theories of Knowledge, 104-05. 32 Ackermann, Theories of Knowledge, 105. Western philosophy.33 His on First Philosophy in particular is remarkable not so much for its conclusions but for its rationalist account of the mind. In many ways, the writings of

Descartes signify the beginning of modern rationality.34

Perhaps as a natural consequence of his epistemological individualism, Descartes also considers the origins and philosophical implications of madness. Interestingly, prominent philosophers interpret his position differently. In Madness and Civilization: A History of Insanity in the Age of Reason, Michel Foucault writes that the label “insane” was popularized during the

Enlightenment,35 and Descartes’s rationalist philosophy certainly had a hand in facilitating that paradigm shift. Moreover, his first meditation arguably draws a “juridical” distinction between reason and madness. In contrast, Jacques Derrida contends that Descartes rejects the idea of the two being mutually exclusive. From this alternate interpretation of the Meditations on First

Philosophy, it follows that an “inability to distinguish between reason and madness is carried over into an inability to distinguish between dreaming and waking life, and further between an evil and benevolent genius, the latter being the point at which a movement between reason and madness will have been entirely fluid.”36 At the same time, when Descartes talks explicitly about madness, he varies between regarding it as an overflow of uncontrolled passions and treating it as a medical problem originating in the brain.37 This contradictory approach is typical of

Descartes’s contemporaries as well: and view madness as an

33 Ackermann, Theories of Knowledge, 101-05. 34 Cernik, Vicenik, and Visnovsky, “Historical Types of Rationality.” 35 Jeffrey L. Powell, “An Enlightened Madness,” Human Studies 25 (2002): 311, doi: 10.1023/A:1020179420806. 36 Powell, “An Enlightened Madness,” 311. 37 Phillips, “Madness of the Philosophers,” 314. excess of passion that dominates reason, although the former notes that the tension between the two qualities is ubiquitous and irreconcilable.38

The beginning of the eighteenth century marked the continued development of

Enlightenment thought, which has profound implications in the history of philosophy. The rationalist influence of Descartes inspired a reaction in the form of , and its proponents carved out a distinctive intellectual niche for themselves. The development of the scientific method changed the way that epistemology was conceptualized: it brought knowledge out of the realm of pure reason and into the quantifiable world of sense experience. In other words, “many philosophers began to take scientific knowledge as the test case for an adequate philosophical epistemology.”39 One of the most prominent empiricists was , although it should be noted that Hume was quite skeptical of sense experience’s supposed revelatory power. accepted the existence of matter and particular non-experienced phenomena;40 went a step further by rejecting them on empiricist grounds.41 In comparison, Hume is positively radical: he believed that sensory experience cannot affirm any sort of knowledge. The best it can do is yield probable knowledge, which is the only grounding available for what we commonly refer to as “knowledge.” As such, “Hume is the first important philosopher… to suppose that certain knowledge was not only a misleading goal for philosophy, but in fact an unattainable goal.”42

Hume’s epistemology, therefore, revises traditional conceptions of empiricism and revolutionizes philosophical ideas about knowledge. Not only does he reject the methods of the

38 Phillips, “Madness of the Philosophers,” 314-15. 39 Ackermann, Theories of Knowledge, 139. 40 Ackermann, Theories of Knowledge, 147-48. 41 Ackermann, Theories of Knowledge, 148, 177. 42 Ackermann, Theories of Knowledge, 177. rationalist school, he also rejects the peculiarly passive version of reason popularized by

Descartes. Other rationalist philosophers like Spinoza had previously questioned the Cartesian view; however, Hume’s writings presented an even sharper critique. For him, reason is not a force that mitigates or contradicts the passions. In fact, the passions constitute a much more compelling force that drives and directs reason toward certain ends.43 Reason does furnish the relationships between different ideas, as in mathematics and , but it certainly cannot deduce or reveal the nature of the world around us.44 It is simply a “reflective passion” that is properly harnessed by temperate, disciplined self-interest.45

Perhaps the most significant aspect of Hume’s intellectual legacy is his marginalization of reason, his rejection of the special status commonly afforded to it by philosophers. In response, sought to restore it as a unique and privileged human faculty. Kant’s characterization of reason positions it differently within different spheres:

In the Critique of Pure Reason, [Kant] argued that pure Reason is impotent in the theoretical sphere, for human knowledge depends on being given its objects from outside Reason. For human beings, the ‘intuition’ on which knowledge depends must be sensuous. Reason is a faculty of non-empirical, universal principles; but human knowledge depends on the senses. ‘Reason,’ in Kant’s sense, is thus confined, in the theoretical sphere, to mere thought; whereas ‘understanding,’ operating in conjunction with the senses, yields genuine knowledge of the world as it must appear to rational beings constituted as we are.46

Interestingly, this description of Kant’s philosophy highlights the influence of Hume’s empiricism. He affords sense experience a rather significant role in his epistemological framework, even though it is complementary to reason. Kant clearly belongs to the rationalist school, but his philosophy constitutes an attempt to synthesize the rationalist ideals of the early

43 Lloyd, Man of Reason, 50-51. 44 Lloyd, Man of Reason, 51-52. 45 Lloyd, Man of Reason, 54-55. 46 Lloyd, Man of Reason, 68. Enlightenment with the (potentially paralyzing) empiricist skepticism of Hume.47 Reason remains “the final court of appeal,” in keeping with the era’s most cherished ideals.48

Nonetheless, Kant’s epistemology reveals how those who followed Hume felt compelled to grapple with the latter’s formidable arguments.

The next philosopher to take up the task of was Georg W. F. Hegel, an intellectual giant. In many ways, his understanding of reason was heavily influenced by Jean-

Jacques Rousseau, who writes extensively about the relationship between reason and nature.

Hegel’s writings, especially the Phenomenology of Spirit, explore this particular aspect of reason in detail. For Hegel, Rousseau’s separation of reason and nature is artificial. In fact, nature is only distinct from reason in the immature stage of rational understanding; enlightenment brings with it the truth that nature is synonymous with Mind (using Hegel’s term).49 Hegel conceives of reason as a process of intellectual and social refinement, “a freedom whose mark was self- imposed obedience to the law” and an advance of consciousness.50 Therefore, reason plays a special role in the slow march of history, for it ensures the progress of civilization toward a moral .51 Reason also operates within the realm of the individual consciousness; as such, madness involves the rational consciousness regressing into the more primitive, bestial part of the soul.52 Even the great Hegel is intellectually indebted to the doctrines of Plato and Aristotle and their understandings of the rational.

The late nineteenth and early twentieth centuries witnessed the birth of and post-modernism, and philosophers reacted accordingly. Since Hume, reason and rationality were

47 Ackermann, Theories of Knowledge, 217-19. 48 Powell, “An Enlightened Madness,” 311. 49 Lloyd, Man of Reason, 70. 50 Lloyd, Man of Reason, 71. 51 Bruner, “History of Thought,” 187-88. 52 Phillips, “Madness of the Philosophers,” 313. not held in the same special esteem, and modern philosophers often adopted his attitude of skepticism. Edmund Husserl began to criticize what he called “irrational ,” “the form of rationality appropriate to branches of inquiry that fail to account for the broader social and political implications of their advancement.”53 He maintains that the use of reason necessarily involves the transformation of particular into universal principles; even the incorporation of contradictory perspectives leads to generalizations as these principles are revised.54 Similarly,

Derrida expressed a desire to “save the honor of reason” by problematizing the concepts of sovereignty and human identity.55 Perhaps most significantly, Foucault grapples with the legacy of Descartes and the Enlightenment at large, laying bare the consequences of elevating reason and rationality to such a privileged position.56 Foucault exemplifies how “the philosophical discourses of today are not simply opposed to the rationality of the Enlightenment. If anything, they appear to up the ante by following reason to its limit.”57 As with many other cherished ideas, post-modern philosophers are interested in deconstructing, even dismantling, our reverence of reason.

Making the Connection Between Epistemology and Psychiatry

As I have illustrated, reason has assumed a rich and complex role in the history of philosophy. Tracking its development necessitates the exploration of social inequality, most notably the marginalization of women and other disenfranchised groups. The inclusion of gender roles in the previous discussion may seem like a non sequitur, but the criteria for rationality have often been intertwined with the high self-esteem of the dominant group. In Western philosophy,

53 Bruner, “History of Thought,” 190-91. 54 Bruner, “History of Thought,” 192. 55 Bruner, “History of Thought,” 195. 56 Powell, “An Enlightened Madness,” 311. 57 Powell, “An Enlightened Madness,” 314. men’s domination of the discourse has entailed an exclusion of perspectives they deem unworthy or less rational. Regardless of philosophers’ intentions, reason has sometimes been wielded as a political weapon, an enforcement of the status quo. In other words, epistemology has often reflected the biases of its contributors.

One interesting question that seems to get lost in the fray is why most philosophers have insisted that rationality is a prerequisite for knowledge. I suspect that Plato’s extensive discussion of it in his writings established a sort of irreversible precedent: from the time of ancient Greece, reason has often been used as a signifier for cognitive normality. Given the fact that Plato references a medical model of mental disorders, his discussion of the subject seems slightly self-contradictory. Nonetheless, it was this notion of rationality as mental health that captivated philosophers’ imaginations. In particular, the common conceptualization of madness was the dominance of unrestrained passion over reason. While this makes sense from a philosophical point of view, it also had the effect of portraying people with mental disorders as fundamentally lacking in and discipline. Thus, mental disorders were understood as the fault of the people who experience them, symbolic of the individual will’s weakness.

(Notably, this attitude is still prevalent in popular culture, particularly concerning non-psychotic disorders like anxiety and depression.)

Even in the twenty-first century, rationality and autonomy continue to be considerations in psychiatric diagnosis. This point is articulated by Rem B. Edwards in an essay entitled, appropriately enough, “Mental Health as Rational Autonomy.” First, Edwards proposes a common definition of rationality:

Now, what is meant by “rational”? Whatever it is, mental disorders are shortcomings or departures from it, and only those disorders which involve the absence of it are to count as mental disorders. Other undesirable mental/behavioral deviations should be classified in other ways, such as intrinsically bad, immoral, criminal, irreligious, etc. … [T]here is widespread agreement among both philosophers and non-philosophers that rationality involves (1) being able to distinguish means from ends and being able to identify processes and manifest behaviors which likely will result in the realization of consciously envisioned goals; (2) thinking logically and avoiding logically contradictory beliefs; (3) having factual beliefs which are adequately supported by , or at least avoiding factual beliefs which are plainly falsified by experience; (4) having and being able to give for one’s behavior and beliefs; (5) thinking clearly and intelligibly, and avoiding confusion and nonsense; (6) having and exhibiting a capacity for impartiality or fair-mindedness in judging and adopting beliefs; (7) having values which have been (or would be) adopted under conditions of freedom, enlightenment, and impartiality. Rationality is a function of how we know, not of what we know. Ignorance is not insanity, but is. Stupidity, the deliberate choice of self-defeating ends, is also not insanity.58

Although there are ambiguities in all definitions of rationality, this one is the most specific and complete that I found over the course of my research. Most importantly, it seeks to distinguish between irrationality and culturally aberrant behaviors and beliefs. Edwards’s effort to separate reason from value judgments is admirable, and his definition uses the best and most rigorous features of epistemology while extracting its biases. This definition will provide the grounding for my discussion of rationality and mental disorders.

As a student of philosophy, I am willing to accept that the ability to reason is a useful criterion for being a knower; it does not make sense to argue otherwise. However, it is possible to be rational and have cognitive abnormalities. Too often, society assumes that the diagnosis of a mental disorder precludes rational understanding, which is patently untrue. There are many diagnoses in the Diagnostic and Statistical Manual of Mental Disorders that do not affect one’s ability to reason, and I would like to address some of them here.

Depression and Monothematic Delusions: A Case Study

58 Rem B. Edwards, “Mental Health as Rational Autonomy,” Ethics of Psychiatry: Insanity, Rational Autonomy, and Mental Health Care, 2nd ed., ed. Rem B. Edwards (Prometheus Books, 1997), 54-55. One diagnosis that does not impair the ability to reason is depression. (Technically, the word “depression” in this context refers to dysthymia or major depressive disorder without psychotic features.59) Famously, the psychologist Aaron Beck proposed that depression necessarily involves cognitive biases and irrational thinking patterns.60 Author George Graham criticizes this claim and contends that depression may be appropriate in specific circumstances, albeit extreme ones: the example that he gives is a prisoner in a Nazi concentration camp.61

Some psychologists go even further than Graham in affirming the hypothesis of “depressive realism”:

We have a tendency to regard people in their ordinary moods as rational information processors, relatively free of systematic bias and distorted judgments. But… [m]uch research suggests that when they are not depressed, people are highly vulnerable to illusions, including unrealistic optimism, overestimation of themselves, and an exaggerated sense of their capacity to control events. The same research indicates that depressed people’s perceptions and judgments are often less biased.62

The hypothesis of depressive realism turns traditional ideas about depression on their head: in certain cases, people with depression are more rational than people without cognitive abnormalities. According to some of the literature, not only is a diagnosis of depression occasionally irrelevant to one’s rational capacity, it can actually enhance it. This does not mean that depression should not be considered a mental disorder; depression can be extremely severe and affect a person’s ability to perform even basic tasks. However, it can include epistemic benefits and certainly does not indicate that the individual experiencing it is irrational. Moreover,

59 American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) (American Psychiatric Publishing, Inc., 2000), chap. 6, http://dsm.psychiatryonline.org.proxyau.wrlc.org/book.aspx?bookid=22. 60 George Graham, “Melancholic Epistemology,” Synthese 82 (1990): 411, http://www.jstor.org/stable/20116761. 61 Graham, “Melancholic Epistemology,” 401-07. 62 Lauren B. Alloy, “Depressive Realism: Sadder but Wiser?”, Harvard Mental Health Letter 11 (1995): 4, http://tinyurl.com/cu3x7zw. there is an important arbitrary criterion for depression in the DSM-IV-TR. At the two-month mark of a bereavement period, the manual states that a diagnosis of depression may be appropriate.63 There is no explanation for the selection of this cutoff, and it seems clear that cultural considerations played a role in its inclusion. These ambiguities and additional considerations make a strong case that depression is not a commentary on a person’s epistemic rationality.

The case of monothematic delusions serves as an interesting, and potentially problematic, diagnosis for our consideration. To be clear, monothematic delusions “are limited to very specific topics”: the idea that a loved one has been replaced by a stranger, for example.64 By definition, delusions are irrational beliefs, but monothematic delusions are difficult because they are limited to one aspect of a person’s life. Philosophers have argued about the epistemic significance of monothematic delusions, with some philosophers asserting that “monothematic delusions are beliefs that are broadly rational responses to highly unusual .”65 It is interesting that this perspective, which provides an empiricist account of delusions,66 explicitly invokes the word “rational.” Given the history I have provided, this is clearly a loaded term, and many philosophers argue that it does not apply to any delusions whatsoever. I tend to agree because arguing that monothematic delusions are rational dilutes the meaning of the mental disorder. However, if the delusion is limited to a very specific portion of a person’s life, it seems plausible that the individual in question could have a capacity for rational understanding.

Speaking philosophically, I worry about the epistemic implications of dividing subjectivity in

63 American Psychiatric Association, DSM-IV-TR, chap. 6. 64 Tim Bayne and Elisabeth Pacherie, “Bottom-Up or Top-Down? Campbell’s Rationalist Account of Monothematic Delusions,” Philosophy, Psychiatry, & Psychology 11 (2004): 1, http://pacherie.free.fr/papers/Bayne-Pacherie-PPP-2004a.pdf. 65 Bayne and Pacherie, “Bottom-Up or Top-Down?”, 2. 66 Bayne and Pacherie, “Bottom-Up or Top-Down?”, 2. this way; that is, is it legitimate to rope off a particular section of the mind? Apparently, some philosophers seem to think so. In fact, it seems that this idea of the mind as multiplicity (to adopt a Nietzschean concept) finds its grounding in the history of philosophy, from Plato to Descartes and beyond. Ultimately, monothematic delusions provide an interesting test case for the irrelevance of mental disorders to rational capacity.

Conclusions and Broader Implications

The DSM-IV-TR is full of diagnoses that could be analyzed from an epistemological point of view. Depression and monothematic delusions are some of the most interesting, but of course, there are many more. It is not my intention to argue that every person with a mental disorder is rational; although the line between rational and irrational is vague, there are clearly people who fall on the latter side. Disorders with psychotic or manic features—major depressive disorder with psychotic features, bipolar disorder, schizophrenia—clearly affect the ability to reason.

However, even people with these mental disorders can use medication to combat dysfunctional behavior and beliefs and to remain lucid. People with mental disorders are often excluded and stigmatized because of their diagnoses, but there is no reason that the philosophical community should follow suit. Perhaps one of the epistemological projects of the twenty-first century should be the incorporation of their perspectives.

It is also important to remember the ethical considerations of this project. The exclusion of epistemological perspectives in the history of philosophy correlated with social inequality for subordinate groups. This subordination was often based on nothing more substantial than the dominant philosophers’ parroting of cultural conventions—in other words, cultural bias. There is no doubt that cultural bias still exists against people with mental disorders, and it would be a significant step for the philosophical community to welcome their knowledge and experiences. This is primarily an epistemological project, to be sure, but it is also an effort to restore dignity to the subjectivities of people with cognitive abnormalities. By acknowledging their personhood, the philosophical community can add a rich new repertoire of voices to its incredible intellectual legacy.